CAMP PERMISSION FORM

I GIVE MY CHILD PERMISSION TO PARTICIPATE ON FIELD TRIPS WITH DOLLY’S SUMMER DAY CAMP (YOU MUST ANSWER YES FOR YOUR CHILD TO ATTEND CAMP ON DATES THAT INCLUDE FIELD TRIPS):

YES / NO

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PHOTOGRAPH PERMISSION:

WE TAKE PICTURES OF OUR CAMPERS DURING FIELD TRIPS AND SPECIAL EVENTS AT CAMP. WE GET DOUBLE PRINTS AND YOU ARE WELCOME TO A COPY OF ANY PHOTOGRAPH OF YOUR CHILD. I GIVE DOLLY’S SUMMER DAY CAMP PERMISSION TO INCLUDE MY CHILD IN PHOTOGRAPHS TAKEN DURING CAMP:

YES / NO

I GIVE DOLLY’S SUMMER DAY CAMP PERMISSION TO HAVE PHOTOGRAPHS TAKEN AT CAMP SENT TO LOCAL NEWSPAPERS FOR PRINTING:

YES / NO

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SUNSCREEN AND INSECT REPELLENT APPLICATION PERMISSION:

I GIVE DOLLY’S SUMMER DAY CAMP PERMISSION TO APPLY:

SUNSCREEN? YES / NO

INSECT REPELLENT? YES / NO

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AUTHORIZATION AND CONSENT:

I UNDERSTAND THAT EVERY EFFORT WILL BE MADE TO CONTACT ME IN THE EVENT OF AN EMERGENCY REQUIRING MEDICAL ATTENTION FOR MY CHILD. HOWEVER , IF I CANNOT BE REACHED, I HEREBY GIVE DOLLY’S SUMMER DAY CAMP PERMISSION TO PROVIDE FIRST AID BY CERTIFIED STAFF OR IF NECESSARY CONTACT MY CHILD’S PEDIATRICIAN OR IF NECESSARY SUMMON EMERGENCY MEDICAL SERVICES TO TRANSPORT MY CHILD TO SOUTH SHORE HOSPITAL.

YES / NO

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PARENT’S SIGNATURE

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DATE ___________________

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PLEASE LIST ANY PEOPLE (OTHER THAN PARENTS) WHO ARE AUTHORIZED TO PICK UP YOUR CHILD.

NAME________________________________________________

ADDRESS_________________________________

RELATIONSHIP________________________________________

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